Forensic Pathologist Details George Floyd Autopsy Report

In regards to the George Floyd autopsy report, Minneapolis police officers arrested George Floyd, a 46-year-old black man, after a convenience store employee called 911. The convenience store told police that Mr. Floyd had purchased cigarettes with counterfeit money. Seventeen minutes after the first squad car arrived at the scene, Mr. Floyd was detained by police and based on video footage was pinned beneath three police officers, showing no signs of life.

In this episode of the Knife After Death podcast we look at the autopsy report of George Floyd. How Dr. Darin Wolfe, a certified forensic pathologist, evaluates the case based on the factual evidence in the report. The transcript of the episode is below.


Transcript of “The George Floyd Final Autopsy Report” Episode – Knife After Death

Thank you for tuning in. I am Dr. Darin Wolfe, a forensic pathologist who is also another term for a medical examiner.

I do autopsies, and some of you know me from my online presence on Instagram, which is called anatomy, and the dead is the account, and some people have seen my YouTube channel, and sometimes it’s Facebook

I’ve been asked to do a podcast many times and never got around to it. But, still, there’s been a lot of stuff come up recently where I felt like I needed to talk to people to maybe teach a little bit um about some of these significant issues that have happened, and I think that it’s just more amenable to talking and doing a show rather than posting a video on Instagram or showing a picture on Instagram.

Why are we here? You’re here because you chose to listen to this podcast. After all, you must have a morbid curiosity about death, or perhaps you’re in a death-related career like mortuary science; maybe you’re a death investigator or a coroner. 

You might be just interested in forensics, or you’re a student. You may be a medical student or a nursing student. There are all sorts of reasons to want to be interested in forensics. 

Importantly it’s to be noted that this podcast is for anybody. The way that I teach the way that I’ve always taught ever since I was in medical school and teaching younger medical students is that I like to teach in a way that anyone can understand, from layperson to professional.

If you’re a layperson with no experience and no understanding of medicine and you’re just curious to listen about what goes on in the world of an autopsy, this is a good podcast for you likewise if you’re a professional or you’re thinking about being professional in that career this is also a good podcast for you.

This podcast, called Knife After Death, will be different from other death-related podcasts. I don’t go as much into history, burial practices, and history of autopsy or surgery. I think that those topics are pretty well-worn at this point.

I want to offer you a journey with me where I am the kind of guide using my hands and eyes and the things that I do during my autopsies um and during death investigations to learn about diseases in the human body. Mostly talking about cases in the news, some historical cases like I know people are always asking me about doing serial killers and various things like that we will get to these sort of things some of them will be my cases and my experiences.

I want us to go on a journey through the human body head to toe and talk about it through the ways that we die, and so the goal is to dispel some myths about death and dying to realize that you know this is a bit of an unusual career for people to conceptualize, but it’s a necessary career. It’s in the news more often than we can imagine, yet people don’t quite understand what goes on during an autopsy. So I’m going to be hitting those topics hard, and you know, in short, I want you to feel like after listening to me talk about these cases after we’ve gone through seasons together. Hopefully, I’ll do more than one season that you feel like you understand what goes on during a death investigation or the autopsy of a human body, so right now, um, the show is just me. It’s just me and my voice and the things that I think I don’t have a co-host yet, and I’m not going to be interviewing anybody at least today now eventually as the show grows and people become, you know, more interested in maybe coming on and giving their opinion.

I want to have some banter, then I’ll bring someone on, but for now, you know I feel like there’s been a lot of urgent issues this year, and I want just to get started so for the episode we’re going to do today.

I had something different in mind as I was going to talk about the difference between cadavers and corpses, and then I was also going to talk about my motivation for being in this field. One of the most asked questions for me is why would you go into forensic pathology, so I was going to give a lovely little, you know, wade into the water episode about kind of my motivations like psychologically to become a forensic pathologist, but then there’s been a significant case that’s occurred in the news one of the most historical events in an already historic year. So I’m speaking about the incident in Minneapolis with a man named George Floyd and his untimely death.

George Floyd’s Death

There’s been a lot of controversy surrounding the autopsy findings, which I have addressed on my YouTube channel and Instagram. But, still, it just doesn’t feel like I’m handling it to the depth that I want to, so that’s why today I am going to go over the autopsy report, and I’m going to do it as a forensic pathologist as a commentator on this field and translate the most important parts for you.

I’m not going to be going over every little detail. Still, I want to talk about autopsy reports and their creation. This one, in particular, is also in context with the preliminary reports that occurred immediately after the autopsy by the Hennepin County medical examiner and then the second so-called independent autopsy that happened, so all that information is together. Separately, we will try to understand and make sense of what was found in the autopsy and then pontificate on how I think that could impact an eventual trial.

We will start with an autopsy created by the Hennepin County medical examiner’s office. The final autopsy report, which was released, I believe June 3rd today is June 4th it was released yesterday, and we’re going to start right on the first page, all right? Now let’s talk about this autopsy report.

What is an autopsy report, and how is it created?

When we do autopsies, whether we’re forensic pathologists or hospital pathologists, we always have to produce an autopsy report that is part of the medical record, and in the case of a legal autopsy, it is part of the legal record. So, hence, this becomes a legal document. It’s used in trials, of course, and it’s also used in things like insurance settlements, and of course, in general, it’s just helpful for the family who is related genetically to the person who died to find out all their underlying medical conditions.

You want to be as thorough as possible, and you want to describe everything in a way, at least this is my personal opinion, that when somebody reads the autopsy report, they can picture everything you’re saying. So we like to be as descriptive as possible. 

Initial Autopsy Report on George Floyd’s Death

This autopsy report on Mr. George Floyd occurred on May 26th, so about 12 hours after he was pronounced dead, an initial preliminary autopsy report caused quite a stir in the media.

I don’t like to demonize the media, you know, just as a term, but I think it was reported that the pathologist’s phrasing was no evidence of asphyxia. I’m paraphrasing a little bit there, but there is no evidence of asphyxia or strangulation by some news outlets, and more how people digested it after that was that there was no asphyxiation despite it being on tape that underlying conditions and or drugs are what caused his death.

Now for those in the field, we saw that preliminary report, and we didn’t think anything about it because it is widespread. Especially in a high profile case like this to pin the autopsy conclusion as the final report manner of death and cause of death until all the information is back so that would be toxicology information looking at the slides the tissue slides under the microscope completed an investigation that sort of thing I’ve made comments how it’s the phrasing is not something I would have used, but I understood it. However, many people did not, and they felt that this was some attempt at a cover-up or to blame the victim for his demise, and that is not the case.

I talked about the preliminary report in a YouTube video. I’m not going to go too much into that right now, but I am going to put it into context with this report because, when the second autopsy came in the independent autopsy, then it complicates things further because that pathologist just straight away said it’s asphyxia due to mechanical compression of the neck now.

Dr. Wolfe’s Take on the County Autopsy

I want to say that that first preliminary was correct in that there was no physical evidence of asphyxia, so as I go through this report, we’re going to talk about what we would see as physical evidence. We know there was evidence of neck compression because it’s on tape, which is essential to note. In forensics, you can have proof of a cause of death if it’s on video or confessed, and the example I gave was suffocation.

When we look at an autopsy of a baby who has been suffocated, we often don’t have that history because what happens is that the caregiver says, “Oh look, I found the baby dead, I don’t know what happened.”. So we do the autopsy, and we don’t find any physical findings, and then at some time later, the person confesses and says, “Well you know I actually suffocated that baby.”, then you can change the cause and manner of death to asphyxia due to suffocation and then of course homicide.

Without that confession or without it being caught on tape, it usually ends up being an undetermined type of case, so the point is that not all the information a pathologist uses to issue their diagnosis is strictly from the body itself. It’s in context with what is found in the other evidence.

George Floyd Mural
A mural of George Floyd painted by the artists Donkeeboy and Donkeemom on the side of Scott Food Mart in Houston, Texas. Credit: Sergio Flores Getty Images

So let’s go on with this autopsy report. This autopsy report is constructed in a way that is very similar to other autopsy reports I’ve seen and my autopsy reports which is that there are findings upfront, which is kind of a summary of everything that the pathologist found that was abnormal and then after the summary, there’s all the really detailed information about the body head to toe. I have to say this is an extremely thorough autopsy, having done many autopsies on my own including hundreds of homicide cases, police cases & legal cases. This autopsy report is as good as it gets in terms of thoroughness there’s no question about that.

I’m just going to start at the beginning and the first part says blunt force injuries. Now that term can cause people to think a certain way when you hear blunt force we think somebody’s been hit with a hammer somebody’s been hit with a baseball bat no blunt force literally means it is a blunt force and that could mean stubbing your toe that could mean you know dropping a hammer on your hand or something like that so that doesn’t mean that an implement was used like a crowbar, it just means that the force was not due to something sharp you know like a knife.

It doesn’t mean that it was due to a gunshot, so it says cutaneous injuries of the forehead face and upper lip mucosal injuries of the lips so that’s like the inside of the lips blunt force injuries to the shoulders, hands, elbows, and legs and pattern contusions in some areas abraded it says of the wrists consistent with restraints.

If you compare this to the video, of course we don’t have a complete history of what happened before he was subdued, but there was some possibly some struggle in that process. Then when he was put on the ground he was face down and of course his face would be you know on the the asphalt on the pavement there and these injuries are consistent with that. These injuries don’t suggest that he was hit necessarily but they don’t strike me as inflicted injuries probably their injuries due to the subdual process and then of course there’s contusions of the wrists which are due to the handcuffs of course.

Use of “Natural Diseases” in the autopsy report

So those are the blunt force injuries then the pathologist moves on to the next part which is natural diseases now here’s this is a part that I find very interesting and as an as a side note um there are people furious at me for saying that I found his natural diseases interesting. People apparently interpreted me saying that as the natural diseases are the cause of death no that’s that’s not what I was saying. 

Natural diseases are important in cases like this because when they go to trial the first thing the defense attorney often asks about is natural disease processes. The second reason why natural disease processes are very interesting to me for this case is that the second pathologist um which I have not seen his autopsy report. There were two pathologists actually, and I haven’t seen if they’ve issued a joint report together um if they do, we’ll talk about that but he at his press conference said that there were no underlying natural diseases to contribute to the cause of death.

It was at odds with the initial report which said there was natural diseases that’s actually a pretty big distinction because at some point they will have to take this to trial if he does not plead guilty and they have to go over basically every line of the autopsy report and so for one pathologist to say that there’s no underlying diseases does that imply that you know he didn’t look hard enough for natural disease because the this autopsy report um outlines natural disease quite well.

Mention and explanation of arteriosclerotic heart disease

The first is arteriosclerotic which is severe underlying heart disease. Okay, so what that refers to is that there are a kind of three major coronary arteries on the heart on the surface of the heart the left anterior descending the right coronary artery and the left circumflex artery. So arteriosclerotic disease is the blockage within the vessels of the heart. Multifocal means it was in many areas of those vessels, and severe of course you know I can’t explain that any better than than what is stated there.

So this is severe arteriosclerotic heart disease, and if you didn’t see my YouTube videos, I’ll explain why that’s important. The heart, of course, is a muscle that needs oxygen in fact it needs a lot of oxygen if you cause a blockage of blood flow to that muscle it cannot get enough oxygen and that is a problem if you do not have enough oxygen and blood coming to the muscle of the heart it gets irritable and it can go into an arrhythmia meaning abnormal heart rhythm. It can even be fatal I would say my most common autopsy overall without question is an autopsy where there is arteriosclerotic or hypertensive heart disease and the person had a fatal arrhythmia and died. So this is significant underlying disease. Again I want to be clear I’m not saying that natural disease is at the root cause of this man’s death but that it is important consideration given the scenario which is a restraint scenario and one in which he may have suffered from difficulty breathing. If you cannot breathe you cannot take in oxygen and if you cannot take in oxygen you are not delivering it to your heart and therefore you’re going to go into cardiac arrest.

Hypertension Described In the Autopsy Report

All right moving on hypertensive heart disease, it says cardiomegaly which means an enlarged heart 540 grams it says and as I read the autopsy report, he’s quite a tall man. He’s six foot four and so the heart um will be more significant as the body gets larger.

Now in a person who’s five foot two 540 grams would be a monstrous heart, but in a man who is um you know six foot four 540 grams is not enormous but slightly above average by 20 or 30 grams. So it says clinical history of hypertension. Hypertension is another word for high blood pressure, so this man had high blood pressure, which is evidenced by the increased size of the heart as I’veI’ve explained before in other videos.

The heart is a muscle and if you contract that muscle against pressure so that’s your blood pressure it will actually thicken and make the heart enlarged there was also a pelvic tumor so a tumor in the pelvis but that did not play any role in the cause of death.

Reference to conjunctival petechiae related to strangulation in the autopsy

Part three is now this is where he says there are no life-threatening injuries identified. Now um that’s interesting because obviously he’s dead, and so this comes to where he the pathologist had originally said that there’s no evidence of asphyxia or mechanical trauma.

Here he says no facial oral mucosal or conjunctival petechiae okay so what are petechiae? Petechiae are little bursts of blood where the blood vessels burst due to increased pressure. So we see that a lot when there’s a strangulation death anything that collapses the blood vessels in the neck and then the blood pressure above the level of the compression is increased. 

As the heart continues to try to beat um the pressure you know will go up and down as let’s say you’re manually strangulating someone the pressure goes up and down up and down it bursts the blood vessels and you see these little dots they look like tiny little dots in the conjunctiva so if you pull your eyelid down that’s the conjunctiva the oral mucosa i.e the gums and the lips and on the face.

If you see sometimes you’ll see it if somebody hangs themselves you’ll see the petechiae there are no injuries to the anterior muscles of the neck or laryngeal structures so the larynx of course is the what we call the voice box and the anterior muscles of the neck are what in medicine we call the strap muscles. When there’s a strangulation type death you will see hemorrhage in those muscles of the neck or you’ll see damage to the laryngeal structures namely the thyroid cartilage which is also known as the adam’s apple and then there’s a u-shaped bone it’s almost like a wishbone type structure right on top of your larynx and it’s called the hyoid bone.

A lot of times in neck compression or strangulation type deaths it will be broken in this case it wasn’t there was no scalp soft tissue skull or brain injuries so no acute head injuries and then um he goes on to say that there was a fracture in the rib due to CPR because after um you know they realized he wasn’t breathing EMS came and they do CPR and very often ribs are broken during CPR this is we’ll talk about this many times if you listen to this podcast we’ll talk about what happens with medical intervention sometimes there are some injuries to the body from medical intervention. 

Incisions Made By the Pathologist on Floyd’s Neck

Then there were incisions that the pathologist made in the posterior that means the back of the neck and the lateral or sides of the neck, the shoulders, the back the flanks the buttocks and these this is extremely thorough this is not a standard procedure we do in a regular autopsy at least most people, but this is one that involved restraint and involved possible asphyxia so all of these incisions are done to see if they’re bruising in those areas so no life-threatening injuries. In other words, no physical evidence of the neck compression have the evidence on the video that hit the headlines.

Testing Showed Floyd was COVID-19 Positive

Viral testing shows positive for the coronavirus. Some medical examiner offices are testing all their bodies for covid and in this case, he was positive immediately. 

I had a lot of people you know email me and say hey does this have anything to do with his cause of death, and to me I think that was more of an interesting finding that they wanted to put in the headline because what’s the two biggest stories of the year COVID-19 pandemic and then now this unfortunate George Floyd death. It didn’t mean anything in terms of this man’s death, but it’s kind of an interesting finding.

Sickle cell genetic finding and how it relates

Next was hemoglobin’s quantitation I’m not going to go into hemoglobin and sickle cell anemia genetics. 

If you have a sickle cell gene it’s hemoglobin sickle cell trait or sickle cell anemia can be problematic for people who have that state of low oxygenation.

The red blood cells will go from a kind of a doughnut shape a disc shape into a sickle shape. I don’t think that this was an acutely a problem for him here, but it was interesting to see that he had a sickle cell trait which is very common in those of African descent as an aside. 

I know some people listening to this will know this but if you have sickle cell trait you actually have what is called a genetic anti-malarial meaning if you have that type of hemoglobin you are less likely to get malaria. It was an evolutionary thing people who kind of you know were in areas of high malaria had a better survival if they had the hemoglobin strait, so that is just a little fun fact for you there.

Toxicology Findings Within Floyd’s System

Next is the toxicology part and I really want to address this because I had a lot of people messaging me and emailing me about the toxicology mention upfront on that first report and they were really angry because they felt that the toxicology said Mr. Floyd had this stuff in his system and therefore he’s a bad person and he’s to blame no that is absolutely not the case.

 I can’t even imagine doing an autopsy without doing talks maybe in the old days they used to just defer on tox but now we pretty much get toxicology on every single body and in this case of course you would because this is going to be probable homicide. It’s going to be a police action type death and you have to know what is in the person’s system.

I don’t think anybody reads that autopsy report and sees the toxicology and makes a judgment about what was in Floyd’s system. My personal autopsies greater than 50 percent may be close to 70 percent of people that autopsy have some kind of illicit substance in their system, but what it does is it gives an insight to possible behavior because certain drugs can affect behavior one way or the other.

Secondly, certain drugs can have effects on your physiology so let’s just start with the report here it says fentanyl. Right off the bat, fentanyl is a very powerful opioid drug it’s about 200 times more powerful than morphine which itself is an already powerful opioid drug and then the second compound is nor fentanyl and the third compound is 4-anp.

These are breakdown products of fentanyl and fentanyl being an opioid can cause respiratory depression and cardiac depression and somnolence which means sort of you know a sleepy state the fourth one listed is methamphetamine which we all know we refer to that as meth.

19 nanograms per milliliter um that is a small amount and then next is the related compounds thc the active ingredient in marijuana the sixth compound is cotinine which is the breakdown product of nicotine so in cigarettes and then seventh is caffeine which is self-explanatory.

So really the ones that stand out here are fentanyl methamphetamine and to a lesser degree thc but I don’t attribute when I see this I do not attribute the behavior like well this guy he’s quote on drugs end quote and therefore he deserved to be restrained that is not what I am saying. 

I don’t think that anybody in the medical examiner’s office is saying that either they have to report these numbers but when it comes time to trial toxicology is I would say a question that I get asked at 100 percent of my murder trials because they have to know what is in the system of the victim. Did that affect his or her behavior in any way? I just want to put that out there that I have to refute a little bit that the toxicology results were released in order to quote make him look bad um that is just simply not true.

 We release toxicology results on every single case the second autopsy that was done, I believe that doctor said that none of these compounds played a role into the death of Mr Floyd and I’m not really going to say whether or not I think that’s true. A person could argue that methamphetamine or fentanyl could have affected his heart function and if you are as being asphyxiated, that is kind of a big deal you need as much heart function as you can possibly have as much oxygen as you can have that sort of thing.

Information In The Urine Drug Screen

Next, we are going to talk about well they did the urine drug screen. There was some morphine there, not sure. I obviously haven’t looked at this guy’s medical record so I don’t know. If they tried to give him morphine were resuscitating him, that would be unusual, let’s put it that way, but it could indicate some usage, but there’s nothing that unusual about the tox report.

I mean it sounds like at the scene there was some concern for intoxication um and again that does not justify the actions of any kind of criminal negligence and restraint resulting in a death because there are lots of people that have substances in their system.

Final note on the first Floyd autopsy report

One interesting thing about the final note on the preliminary find on the front finds the front page findings is that um the doctor says the decedent was known to be positive. When we say decedent that refers to the person who they autopsied was known to be positive for COVID rna, sorry that’s ribonucleic acid that’s the genetic material of the virus on April 3rd so we’re talking six weeks ago seven weeks ago he was COVID positive.  

Then the doctor goes on to say positivity for covid RNA can persist for weeks and they think that this in fact was an asymptomatic PCR that’s the test that they use positivity from the previous infection and not that Mr. Floyd was um positive and actively symptomatic for covid and that it had anything to do with his death.

Text body of the autopsy report detailing George Floyd’s Death

After this the now is what we call the body of the autopsy report which really goes into a lot of detail and I’m certainly not going to go over every line but Mr Floyd talks about his height and weight he was six foot four 223. A big guy and then it goes over just for those of you who haven’t seen autopsy reports this is broken into the external examination and the internal examination.

The external examination is exactly what it sounds like you don’t touch the body, and you describe everything you see, so we’re talking about you know hairstyle, hair color, eye color, teeth condition, presence of scars, presence of piercings, description of tattoos things like that.

It’s this is the part where you really are describing the person in a way that when somebody reads the report they can picture it in three dimensions now there was extensive evidence of medical intervention in this case which is important to note because we know that Mr. Floyd lost consciousness and EMS were called and there was a quite aggressive um attempt at medical resuscitation. This was too late and it did not have an effect. He was unable to be revived.

Evidence of injury, abrasions & contusions

Now the other section of the autopsy report pathologists very typically have a section just referred to as evidence of injury and so basically you go head to toe both externally and internally and you talk about the injuries that you see and for Mr floyd’s evidence of injury it’s quite extensive because as pathologists we have to we have to list everything we see. The tiniest little abrasion that’s the size of a pinpoint we have to describe that the tiniest little scrape even if it’s if it looks like it’s not recent. 

We have to describe every single thing head to toe, and so he goes on for about two pages describing various scratches various abrasions some contusions. There were some contusions on the face and what I see here and I’m not going to go over every abrasion and contusion because we wouldn’t even do that in court, but the idea is does it fit with the scenario of him being restrained and then pinned to the ground and all of these injuries are fairly superficial. 

So we’re talking about abrasions and contusions. There were a couple of small mucosal lacerations in the mouth, and that does fit with what we saw in the video. There was no extensive injury such as fractures of the spine, fractures of the posterior ribs, or that is the back part of your ribs, fractures of the neck or very deep hemorrhage.

Internal Examination of Mr. Floyd

So now basically at this point, we go to the internal examination on this case and the internal examination is exactly what it sounds like. So as a pathologist, when we do an autopsy, we look at the organs of the head, the neck, the chest, the abdomen, the pelvis, and any other areas of the body that needs to be dissected.  

In this case, some pathologists start with the head and go down. Other pathologists start with the body organs of the chest and the abdomen and then they sort of do the head last. In this case, they started with the head, and that doesn’t necessarily mean that that’s the order of the autopsy that’s just the order that it’s put in the report.

There were no injuries or pathology to the brain basically, so when we open the head, we’re going to look for scalp injuries we’re going to look for deep bruises of the head, subcutaneous tissue, the temporalis muscles, which are on the side of the head. You’re going to look for skull fractures of note that were present. They didn’t have any hemorrhages in the brain itself, which would also indicate kind of a blunt force injury to the head.

Neck dissection: Most important part of the Floyd autopsy

Now next this is probably the most important part of the autopsy is the neck dissection. I can just tell you it says layer by layer dissection of the anterior strap muscles of the neck discloses no areas of contusion or hemorrhage within the musculature. Now that’s that’s a that’s a very um specific forensic procedure called a forensic nectar section or a layered nectar dissection. Why is it called that? Because the muscles of the neck if some of you have had anatomy you know this and if you haven’t, you can google it or look up an anatomy book.

The muscles of the neck are in layers and basically what you do is you take your scalpel and you dissect each muscle and you reflect it all the way back and you look at the top of the outward-facing portion, and then the underside of the muscle itself. You look for hemorrhages, you look for rupture of the muscle, and this is most commonly seen in what we call manual strangulation. so when somebody has put their hands around somebody’s neck and really squeezed it, you can see rupture and hemorrhage of the neck muscles, and we did not see that in this case, it was not described.

Next is the thyroid cartilage and hyoid bone are intact, so the thyroid cartilage is more prominent in males we call that the adam’s apple and then the hyoid bone is like I said the u-shaped bone on the top of the larynx. 

Those are two areas we look at when we’re worried about neck injury due to strangulation or compression and they were intact so overall and then they talk about the thyroid they talk about the cervical spine and it’s all free of hemorrhage so there is no physical evidence of injury to the neck. As you know, I’ve described before in some of my videos you don’t necessarily need to see those injuries to suffer an asphyxial death the classic example would be a suicidal hanging so if someone were to take a belt or a rope or something around their neck and hang from a beam and die and be found and autopsied most often the neck it looks perfectly fine. There’s no, I mean, there is a ligature mark, but there’s no hemorrhage in the muscles, and there’s no fracture of the highway bone . Occasionally you can see fractures in the hyoid bone, but I’m not going to go into that right now we can talk about that later with um another famous case that was in the news last year.

So again we go through the respiratory system we go through the body cavities here the lungs were quite heavy so the lungs were a total of over 2000 grams lungs for an adult should be a total of about 700 grams so this was about three times normal and we see pulmonary edema or pulmonary congestion with the cardiac failure because basically what happens is when the heart stops moving blood forward there’s still blood return into the lungs and then it can cause pulmonary congestion also opioids such as fentanyl or morphine can cause that kind of congestion.

Details on the Cardiovascular System

Now we’re going to get into the specifics of the heart so the cardiovascular system here we have the heart was of course heavy 540 grams by a little bit, but most importantly here we have 75 percent occlusion in the left anterior descending artery and the 90 occlusion in the right coronary artery. So this would qualify as severe arteriosclerosis or atherosclerosis. Like I said before if you have blockages in the arteries of your heart you are going to be more likely to develop an arrhythmia and so early on people were were upset because they they were suggesting they thought it was being suggested that Mr. Floyd was having a heart attack and that the death wasn’t related to the um kneeling incident and actually some people got angry at me for you know talking about the heart. 

The fact is if the man we didn’t know at the time if the man may have been having a cardiac condition at the time of his arrest and so that’s why to me the heart disease was important it doesn’t appear that there was active myocardial infarction or heart attack in this case but it is worth noting that his heart disease was severe enough to where if you’re going to restrict oxygen to a heart with that much blockage that’s going to be a major problem and again he obviously went into cardiac arrest and had an arrhythmia.

The rest of the internal organs are fairly straightforward, fairly normal they you know I’m I’m not. It’s not really worth going into every detail and talking about the adrenal glands and things like that but basically staying with the important relevant to the case portions.

Special Procedures on George Floyd

Now um they have a section called “special procedures” where they talk about in incising or cutting into the wrists to look for hemorrhage and there was some hemorrhage in the wrist which is not surprising because um there was cuffing of the hands and so you know when that happens you’re gonna have some some hemorrhage. 

It’s when we think of hemorrhage I think sometimes people think of blood squirting out like crazy but no hemorrhage or hematoma is just a collection of blood. It can be a very small collection of blood and people use the term subcutaneous hemorrhage and then of course the the body was extensively dissected to look for those type of blunt tissue or blunt force injuries and you know it’s that they just weren’t there and as we saw the man was kneeled upon by multiple police officers and that kind of force isn’t going to produce the pressure necessary where you would see the physical findings, but could be a enough pressure to actually produce death. Keep in mind it only takes about 10 pounds of pressure to cut off the vessels of the neck, so that is obviously more than 10 pounds of pressure if somebody’s kneeling on your neck.

Microscopic Indicators within the Floyd case

Now I did want to address that I used to be a surgical pathologist, so I did want to address the heart and the tissue slides. What happens is that in an autopsy, we take sections of every single organ, and what I mean by sections is little pieces we put it in formaldehyde. It’s a solution actually called formalin, and then we actually make slides out of those on glass slides just like you did in science class.

We look at them under the microscope and we can make diagnoses based on that. I was very curious if Mr. Floyd might have been having a myocardial infarction at the time of his arrest, which could have hastened his death, but if he was having a myocardial infarction, you should see some cellular changes notably the early cellular changes you would see are what’s called neutrophils.

Neutrophils are the cells of acute inflammation of your body and so if you have an acute inflammation, I mean, it can be anything you can have an infection or you can have some kind of you know injury to the body neutrophils are very early cells to respond to that and so if we had seen some neutrophils or some unusual looking heart cells then we we could have thought maybe he was having an early heart attack. In fact the microscopic examination of the heart did not reveal any of that. 

Secondly um we heard that the man was COVID-9 positive and we are learning more and more that COVID-19 is a blood vessel disease. What I mean by that is they are it looks like there’s evidence that the virus is directly infecting blood vessels and it’s causing blood clots which is why you have people who are dying of heart attacks, people who are dying of pulmonary embolism, people who are dying of stroke when they have covid and there was some controversy people saying that death certificates are being filled out inappropriately because if somebody dies of a heart attack and has COVID they shouldn’t be called COVID well. 

We know that covid is now a blood vessel disease, so if you are clotting off blood vessels in your heart, then, by definition, you’re going to cause a heart attack. So in this case George Floyd, there was no evidence of clots or what we call thrombin in the lungs or the heart or the brain. 

So covet 19 was kind of what we call red herring. It’s something that’s there but doesn’t really mean anything it takes your attention away so overall analysis. 

That’s the summary of the autopsy report from what we know, but it’s more detailed information and so, you know, I hope with this one being released so fast that it kind of calms down the um the controversy that had occurred early on because you know early on when that first preliminary came out. I mean people went nuts. I don’t know if you were on twitter, but there were a lot of people who suddenly had degrees in medicine and forensics who were experts on that and really raked the whole autopsy report over the coles understandably.

I can see the the phrasing would be misconstrued by people who are not in the field, and that’s the takeaway I want to tell any listeners who might be thinking about going into forensics or medicine, but frankly, I think it applies to any job whenever you’re doing something. Think about it being scrutinized to five or ten years from now you want to be able to defend your work. When I do an autopsy, I think about it being in court two years from the day, and I have to sit there and answer to it. I try not to do any odd phrasing or or anything that could be possibly controversial.

Legal implications of how Floyd died

I’m not going to talk too much about the legal implications of this case. I know they’ve changed the it was a third degree murder and then now they move it to second degree murder. I’ve had people ask me legal questions and I do love the legal side of forensic medicine and I will do podcasts on that but for the most part I feel like now is not the time.

I kind of want to focus on what my lane is which is the autopsy report so I hope that this has helped you understand it a little bit better if you want to see my descriptions of the the preliminaries for both um the first autopsy preliminary released by Hennepin County or the preliminary which was sort of just a press conference by the consulting independent pathologist you can find those on my youtube channel which has the same name as this podcast which is Knife After Death.

Show Closing on George Floyd Episode

So this is episode 1, and we are now done with episode one it’s not the episode that I was gonna start with but I feel like this was urgent enough to go ahead and kick off with a case that’s in the media right now and one that has global societal implications. Then we can learn from and this is just my little piece of it, the the medical examiner piece, which is a one part of the pie that is going to reverberate for a long time.

I have a feeling and hopefully, we come through it better we come through it having learned something. I hope you enjoyed this and we will have what was supposed to be the inaugural episode we will actually do that next hopefully and thank you for listening. I greatly appreciate it.